Karakteristik pasien fraktur kruris di RSUD Sanjiwani Gianyar tahun 2020

Background: The location of the most fractures in traffic accident victims is the lower extremity bone. Data from the Basic Health Research (Riskesdas) also shows that fractures in the lower extremities due to traffic accidents have the highest prevalence among other fractures. Cruris fractures generally occur as a result of high-energy trauma such as a traffic accident or low-energy torsional trauma. The increase in cases of trauma, especially traffic accidents cause an increase in the incidence of tibial and fibular fractures. This study aims to determine the prevalence and characteristics of cruris fractures at the Sanjiwani Hospital, Gianyar in 2020.

Methods: The design of this study was retrospective descriptive using 30 samples of cruris fractures taken from secondary data from patient medical records at the Sanjiwani Hospital, Gianyar. The variables of this study included gender, age, cause of fracture and type of cruris fracture. Data analysis using SPSS software.

Results: The most common fractures of the tibia and fibula occurred in male patients (56%). The age group most frequently experiencing cruris fractures is the adult age (18-59 years). The most common cause of cruris fractures was traffic accidents as many as 19 people (64%). The most common type of cruris fracture found in this study was a fracture of the tibia fibula as many as 21 people (70%).

Conclusion: The most common cruris fractures are tibia and fibula fractures in men, with the most common cause of traffic accidents. This study is expected to be able to become a basic data material for conducting a wider study on the prevalence and characteristics of cruris fractures in Bali, so that the public can be more aware of the incidence of fractures that still occur frequently.

Latar belakang: Lokasi fraktur terbanyak pada korban meninggal kecelakaan lalu lintas adalah pada tulang bagian ekstremitas bawah. Data dari Riset Kesehatan Dasar (Riskesdas) juga menunjukkan bahwa fraktur pada ekstremitas bawah akibat kecelakaan lalu lintas memiliki prevalensi yang paling tinggi diantara fraktur lainnya. Fraktur kruris pada umumnya terjadi akibat trauma dengan energi tinggi seperti kecelakan lalu lintas atau trauma torsional energi rendah. Peningkatan kasus trauma, terutama kecelakaan lalu lintas menyebabkan peningkatan insidens fraktur tibial dan fibular. Penelitian ini bertujuan untuk mengetahui prevalensi dan karakteristik dari fraktur kruris di RSUD Sanjiwani Gianyar pada tahun 2020.

Metode: Rancangan penelitian ini adalah deskriptif retrospektif dengan menggunakan 30 sampel fraktur kruris yang diambil dari data sekunder rekam medis pasien di RSUD Sanjiwani Gianyar. Variabel penelitian ini meliputi jenis kelamin, usia, penyebab fraktur dan jenis fraktur kruris. Analisa data menggunakan perangkat lunak SPSS.

Hasil: Fraktur tibia dan fibula paling banyak terjadi pada pasien laki – laki (56%). Kelompok usia yang paling sering mengalami fraktur kruris adalah usia dewasa (18 – 59 tahun). Penyebab terbanyak fraktur kruris adalah kecelakaan lalu lintas sebanyak 19 orang (64%). Jenis fraktur kruris tersering yang ditemukan pada penelitian ini adalah fraktur tibia fibula sebanyak 21 orang (70%).

Simpulan:  Fraktur kruris paling banyak didapatkan adalah fraktur tibia dan fibula pada laki-laki, dengan penyebab tersering kecelakaan lalu lintas. Penelitian ini diharapkan mampu menjadi bahan data dasar untuk dilakukannya penelitian lebih luas mengenai prevalensi dan karakteristik fraktur kruris di Bali, sehingga masyarakat dapat lebih waspada mengenai kejadian fraktur yang masih sering terjadi.

Pemberian pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi pada soket mandibula daripada pasta ekstrak daun mengkudu 10% pasca pencabutan gigi marmut jantan

Background: The process of wound healing after a tooth extraction is expected to occur more quickly to restore normal functioning of the tissue and reduce the risk of complications. Pegagan leaf (Centella asiatica) and mengkudu leaf (Morinda citrifolia. L) contain active compounds such as flavonoids, tannins, and triterpenoids that accelerate wound healing. This study aims to evaluate the pegagan leaf extract paste increased the number of fibroblast cells and reepitelization more than mengkudu leaf extract paste after tooth extraction.

Methods: This study used a post-test-only control group design to the 30 male guinea pigs. The three groups were the placebo paste group, the pegagan leaf extract paste 10% group, and the mengkudu leaf extract paste 10% group, which were treated for 6 days. Examination of the number of fibroblast cells and reepitelization was carried out by taking tissue of the mandibular socket on day 7, histological preparations with HE staining were made. The data obtained were analyzed by SPSS version 20 for Windows

Results: The average difference in the number of fibroblast cells and reepithelization showed a significant difference (p<0.05) between groups. The highest average for the number of fibroblast cells was found in the group that applied topically with pegagan leaf extract paste 10% was 97.98±25.67 cells followed by the group that applied topically with mengkudu leaf extract paste 10% was 64.28±12.22 cells and the group applied topically with placebo paste was 46.36±14.27 cells. The highest average for the reepithelization was found in the group that applied topically with pegagan leaf extract paste 10% was 69.64±24.53 µm.

Conclusion: It was concluded that pegagan leaf extract paste 10% increased the number of fibroblast cells and reepitelization than mengkudu leaf extract paste 10%.

Latar Belakang: Proses penyembuhan luka setelah pencabutan gigi diharapkan lebih cepat terjadi sehingga dapat mengembalikan fungsi normal dari jaringan dan mengurangi risiko terjadinya komplikasi. Daun pegagan dan daun mengkudu mengandung senyawa aktif seperti flavonoid, tanin dan triterpenoid yang dapat mempercepat penyembuhan luka. Penelitian ini bertujuan untuk mengevaluasi ekstrak daun pegagan dalam meningkatkan jumlah sel fibroblas dan reepitelisasi daripada pasta ekstrak daun mengkudu pasca pencabutan gigi.

Metode: Penelitian ini menggunakan rancangan post-test only control group design terhadap 30 ekor marmut jantan. Terdapat 3 kelompok secara acak yaitu kelompok pasta plasebo, kelompok pasta ekstrak daun pegagan 10% dan kelompok pasta ekstrak daun mengkudu 10% yang diberikan perlakuan selama 6 hari. Pemeriksaan jumlah sel fibroblas dan reepitelisasi dilakukan dengan pengambilan jaringan soket mandibula pada hari ke 7, kemudian dibuat preparat histologis dengan pengecatan HE. Data yang diperoleh dianalisis menggunakan uji SPSS versi 20 untuk Windows.

Hasil: Perbedaan rerata jumlah sel fibroblas dan reepitelisasi menunjukkan perbedaan yang signifikan (p<0,05) antar kelompok. Rerata jumlah sel fibroblas tertinggi terdapat pada kelompok yang diolesi pasta ekstrak daun pegagan 10% dengan rerata yaitu sebesar 97,98 ± 25,67 sel diikuti oleh kelompok yang diolesi pasta ekstrak daun mengkudu 10% dengan rerata sebesar 64,28 ± 12,22 sel dan kelompok yang diolesi pasta plasebo dengan rerata sebesar 46,36 ± 14,27 sel. Sedangkan rerata reepitelisasi tertinggi terdapat pada kelompok yang diberi pasta ekstrak daun pegagan 10% dengan rerata yaitu sebesar 69,64 ± 24,53 µm.

Kesimpulan: Dapat disimpulkan bahwa pasta ekstrak daun pegagan 10% lebih meningkatkan jumlah sel fibroblas dan reepitelisasi daripada pasta ekstrak daun mengkudu 10%. 

Colonoscopy surveillance of colorectal cancer post-surgery in Sanglah General Hospital, Bali, Indonesia: a descriptive study

Background: The postoperative surveillance of patients treated for colorectal cancer is intended to prolong survival by diagnosing recurrent and metachronous cancers at a curable stage as well as preventing metachronous cancer by detection and removal of precancerous polyps. This study evaluates the surveillance colonoscopy and its association with sociodemographic and clinical findings in a descriptive study.

Methods: This is a cross sectional study of colorectal cancer patients who underwent surveillance colonoscopy as follow up after tumor resection from January 2020 to September 2021 in Sanglah General Hospital. Clinical data were gathered from medical records and databases by a qualified reviewer. Data were analyzed descriptively using SPSS version 20 for Windows.

Results: The majority of patients who underwent surveillance colonoscopy were male (82.40%), tumor location at rectum (58.8%), stage IV (29.40%), underwent low anterior resection surgery (35.30%) and received Folfox (35.30%) or Capeox (35.30%) adjuvant chemotherapy. There was 2 (11.80%) residual mass found in this study. There was no significant difference between subjects who underwent surveillance colonoscopy with residual mass and without residual mass in all variables assessed (p>0.05).

Conclusion: Colonoscopy surveillance plays an important role in early detection for any recurrence or pre-cancer lesion and metachronous cancer in a patient with colorectal malignancies in Sanglah General Hospital, Bali, Indonesia. 

Angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, Indonesia

Background: Nutritional support is an important aspect of the clinical management of hospitalized children. Several factors contribute to prevalence of malnutrition in hospitalized children and it can led to deterioration of nutritional status. Research on factors related to malnutrition in pediatric hospitalized patients is still limited, especially in Indonesia. This study aims to evaluate the incidence rate and risk factors of malnutrition in hospitalized children at Sanglah General Hospital, Bali, Indonesia.

Methods: This study was a prospective analytic observational study in children who underwent hospitalization in class II and III inpatient rooms for the period August 2020-February 2021. Inclusion criteria were pediatric patients aged 1 to 18 years who were hospitalized for at least 48 hours and had complete medical records. Samples were taken by consecutive sampling until the number of subjects was met. A significant variable is a variable that has a p-value <0.05. Data were analyzed using SPSS version 20 for Windows.

Results: A total of 95 subjects who met the inclusion and exclusion criteria. The incidence of hospital malnutrition was 28%. The risk factors associated with hospital malnutrition were fever, diarrhea and vomiting. Multiple diagnosis, acute and chronic malnutrition, low maternal education, surgical and medical departments also contribute to hospital malnutrition. The results of multivariate analysis were acute malnutrition and length of stay as independent risk factors for hospital malnutrition (OR, 3.843; 95% CI, 1.762-5.431; p=0.005) and length of stay (OR, 5.791; 95% CI, 2.157-6.491; p=0.026)

Conclusion: The incidence of patients with hospital malnutrition in children at Sanglah Hospital Denpasar is 28%. Acute malnutrition and length of stay are independent risk factors for malnutrition during hospitalization.

Latar belakang: Dukungan nutrisi adalah aspek penting dalam manajemen klinis anak yang dirawat di rumah sakit. Beberapa faktor berkontribusi terhadap meluasnya malnutrisi pada anak yang dirawat di rumah sakit dan menyebabkan eksaserbasi status gizi.  Penelitian mengenai faktor-faktor yang berkaitan dengan malnutrisi pada pasien pediatri yang menjalani rawat inap masih sangatlah terbatas khususnya di Indonesia meskipun memiliki urgensi yang tinggi. Penelitian ini bertujuan untuk mengevaluasi angka insiden dan faktor risiko malnutrisi rumah sakit pada anak rawat inap di RSUP Sanglah, Bali, Indonesia

Metode: Penelitian ini merupakan penelitian observasional analitik pada anak dengan metode penelitian kohort prospektif yang menjalani rawat inap di ruang rawat inap kelas II dan III periode bulan Agustus 2020-Februari 2021. Kriteria inklusi yaitu pasien anak berusia 1 hingga 18 tahun, menjalani rawat inap di RS minimal 48 jam, dan memiliki catatan medis yang lengkap. sampel diambil secara konsekutif sampai jumlah subyek terpenuhi. Variabel yang signifikan adalah variabel yang mempunyai nilai p<0,05. Data dianalisis dengan SPSS versi 20 untuk Windows.

Hasil: Sebanyak 95 subjek yang memenuhi kriteria inklusi dan eksklusi. Insiden malnutrisi rumah sakit didapatkan sebesar 28%. Faktor RISIKO yang berhubungan dengan malnutrisi rumah sakit adalah demam, diare dan muntah. Diagnosis multipel, kurang gizi akut dan kronis, lama rawat,pendidikan ibu rendah, dan departemen rawat juga sebagai faktor RISIKO malnutrisi rumah sakit. Hasil analisis multivariat dilakukan dengan hasil kurang gizi akut dan lama rawat sebagai faktor risiko independen terjadinya malnutrisi rumah sakit (OR, 3.843; 95% CI, 1.762-5.431; p=0.005) dan lama rawat (OR, 5.791; 95% CI, 2.157-6.491; p=0.026)

Simpulan: Insiden pasien dengan malnutrisi rumah sakit pada anak di RSUP Sanglah Denpasar adalah sebesar 28%. Kondisi kurang gizi akut dan lama rawat merupakan faktor risiko independen terjadinya malnutrisi selama perawatan di rumah sakit.

Perbandingan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai terapi anemia pada pasien yang menjalani hemodialisis reguler: meta analisis

Introduction: Chronic kidney disease (CKD) is a global health problem. Hemodialysis (HD) is one of the treatment modalities for end-stage renal disease which is commonly used. A complication that is often found in patients undergoing regular HD is anemia. Roxadustat is a prolyl hydroxylase inhibitor (PHI) which has a potential as an alternative therapy for anemia in patients undergoing regular HD. The aim of this meta-analysis was to compare the efficacy and safety of roxadustat and epoetin alfa as anemia management in patients undergoing regular HD.

Methods: We searched the literature sources in the PubMed, MEDLINE, Cochrane, Scopus, Embase, Elsevier, and Proquest databases until June 1, 2021. The search terms used were chronic kidney disease, hemodialysis, dialysis, roxadustat, epoetin alfa, anemia management, incidence of side effects, randomize, and randomization. We excluded the study population with acute kidney injury/dyslipidemia/metabolic syndrome. All analyzes in this meta-analysis were performed using Review Manager version 5.3 (RevMan Cochrane, London, UK).

Result: We have found five eligible studies (2777 patients). Funnel plots and p-Egger were examined to assess publication bias. The results showed a statistically significant difference between roxadustat and epoetin alfa with respect to the mean difference of hemoglobin (Hb) (WMD: 0.31; p<0.05), hepcidin (WMD: -18.94; p<0.05), transferrin (WMD: 67.88; p<0.05), transferrin saturation (WMD: 2.78; p<0.05), iron (WMD: 5.02; p<0.05) and risk of adverse events (OR: 1.25; p<0.05) displayed on the forest plot.

Conclusion: Based on this meta-analysis, it can be concluded that anemia management with roxadustat is better than epoetin alfa in patients undergoing regular HD.

Latar Belakang: Penyakit ginjal kronis (PGK) merupakan masalah kesehatan global. Hemodialisis (HD) merupakan salah satu modalitas terapi PGK stadium akhir yang umum digunakan. Komplikasi yang sering ditemukan pada pasien yang menjalani HD reguler adalah anemia. Roxadustat adalah suatu prolyl hydroxylase inhibitor (PHI) yang memiliki potensi sebagai alternatif terapi anemia pada pasien yang menjalani HD reguler. Tujuan dari meta-analisis ini adalah untuk membandingkan efektivitas dan keamanan antara roxadustat dan epoetin alfa sebagai manajemen anemia pada pasien yang menjalani HD reguler.

Metode: Kami mencari sumber literatur pada database PubMed, MEDLINE, Cochrane, Scopus, Embase, Elsevier, dan Proquest hingga 1 Juni 2021. Istilah pencarian yang digunakan yaitu penyakit ginjal kronis, hemodialisis, dialisis, roxadustat, epoetin alfa, manajemen anemia, kejadian efek samping, acak, dan pengacakan. Kami mengeksklusi populasi penelitian dengan cedera ginjal akut/dislipidemia/sindrom metabolik. Semua analisis dalam meta-analisis ini dilaksanakan dengan menggunakan Review Manager versi 5.3 (RevMan Cochrane, London, UK).

Hasil: Kami menemukan lima studi yang memenuhi syarat (2777 pasien). Funnel plot dan p-Egger diperiksa untuk menilai bias publikasi. Hasil menunjukkan perbedaan signifikan secara statistik antara roxadustat dan epoetin alfa terhadap perbedaan rerata dari hemoglobin (Hb) (WMD: 0,31; p<0,05), hepsidin (WMD: -18,94; p<0,05), transferin (WMD: 67,88; p<0,05), saturasi transferin (WMD: 2,78; p<0,05), zat besi (WMD: 5,02; p<0,05) dan risiko kejadian efek samping (OR: 1,25; p<0,05) yang ditampilkan pada forest plot.

Kesimpulan: Berdasarkan meta-analisis ini, dapat disimpulkan bahwa manajemen anemia dengan roxadustat lebih baik dibandingkan dengan epoetin alfa pada pasien yang menjalani HD reguler.

Efek ekstrak sambiloto (Andrographis paniculata) terhadap ekspresi vascular cell adhesion molecule-1 (VCAM-1) dan intimal media thickness (IMT) pada mencit yang terpapar asap rokok

Introduction: Sambiloto (Andrographis paniculata) is a plant that spread almost throughout the Indonesian archipelago and has been used for a long time as traditional medicine. Several previous literatures reported that sambiloto has anti-inflammatory and antioxidant effects, so its use is useful in cardiovascular disease, especially in reducing the process of atherosclerosis. The purpose of this study was to determine the effect of giving sambiloto extract on markers of inflammation and atherosclerosis in the form of VCAM-1 expression and IMT in mice exposed to cigarette smoke.

Methods: This study used an experimental analytical method with a post-test-only group design. Using 32 healthy adult male mice weighing 20-30 grams were divided into four treatment groups, namely: control group (P0) only given exposure to cigarette smoke and treatment group 1 (P1), 2 (P2), and 3 (P3) given exposure cigarettes and sambiloto extract with doses of 18, 29, and 40 mg/kg/day. Exposure is given for 60 days, then the VCAM-1 expression and IMT in the aortic arch were examined histologically.

Results: There were significant differences in VCAM-1 expression and IMT between the control group and all treatment groups. There was a significant decrease in VCAM-1 expression between P1 and P2 and P2 and P3. There was a significant decrease in IMT between P1 and P2 and P2 and P3.

Conclusion: Sambiloto extract has effect in decreasing VCAM-1 expression and IMT. That effect strengthens with increasing dose. The maximum effect is obtained with the use of a dose of 40 mg/kg/day.

Latar Belakang: Sambiloto (Andrographis paniculata) merupakan tanaman yang tersebar hampir di seluruh nusantara dan telah digunakan sejak lama oleh masyarakat Indonesia sebagai obat tradisional. Dari beberapa literatur sebelumnya melaporkan sambiloto memiliki efek antiinflamasi dan antioksidan sehingga bermaafaat dalam bidang penyakit kardiovaskular terutama mengurangi proses aterosklerosis. Tujuan dari penelitian ini untuk mengetahui efek pemberian ekstrak sambiloto terhadap petanda inflamasi dan atherosklerosis berupa ekspresi VCAM-1 dan IMT pada mencit yang terpapar asap rokok.    

Metode: Penelitian ini menggunakan metode analitik eksperimental dengan rancangan post test only group design. Menggunakan 32 ekor mencit jantan dewasa kondisi sehat dengan berat 20-30 gram dibagi menjadi empat kelompok perlakuan yaitu kelompok kontrol (P0) hanya diberikan paparan asap rokok dan kelompok perlakuan 1 (P1), 2 (P2), dan 3 (P3) diberikan paparan rokok sigaret dan ekstrak sambiloto dengan dosis 18, 29, dan 40 mg/kg/hari. Paparan diberikan selama 60 hari, kemudian dilakukan pemeriksaan histologi ekspresi VCAM-1 dan IMT pada arkus aorta mencit.

Hasil: Terdapat perbedaan yang bermakna ekspresi VCAM-1 dan IMT antara kelompok kontrol dengan semua kelompok perlakuan. Terdapat penurunan bermakna ekspresi VCAM-1 antara P1 dengan P2 dan P2 dengan P3. Terdapat penurunan bermakna tebal IMT antara P1 dengan P2 dan P2 dengan P3.

Simpulan: Ekstrak sambiloto memiliki efek menurunkan ekspresi VCAM-1 dan tebal IMT. Efek tersebut meningkat dengan peningkatan dosis. Efek maksimal diperoleh dengan penggunaan dosis 40 mg/kg/hari.

Efek pemberian formulasi SMEDDS ekstrak biji kedelai (glycine soja) terhadap kadar LDL dan HDL pada tikus yang diinduksi jantung koroner

Introduction: Coronary heart disease is one of the national health problems that gets attention. One of the efforts to develop the treatment of coronary heart disease includes the use of natural ingredients such as soybean seed extract which contains aglycone isoflavones which affect preventing endothelial dysfunction and reducing LDL levels in the blood, where high LDL levels and low HDL levels in the blood are one of the factors. The risk of coronary heart disease. Aglycone isoflavone compounds are non-polar compounds that are difficult to dissolve in water, so they require other ingredients to increase the absorption of aglycone isoflavones, one of which is the Self Microemulsifying Drug Delivery System (SMEDDS) formulation that can help improve solubilization and access drug to lymphatic tissue

Methods: This experimental study was conducted with a post-test only approach. The research sample used 35 white rats which were divided into the first group which was given a normal diet, the second group which was given a high-fat diet and the third to fifth groups which were given a high-fat diet and the SMEDDS formulation of soybean seed extract. The SMEDDS formulation of soybean seed extract was administered at 200 mg/mL, 300 mg/mL and 400 mg/mL using a probe for seven days, twenty-one days after rats were induced with coronary heart disease with a high-fat diet. The rat blood was then taken for analysis of LDL and HDL levels. Data were analyzed by SPSS for windows.

Results: The results showed that there was no significant difference in LDL and HDL levels from each experimental group (p>0.05). This can be caused by the short period of administration of the SMEDDS formulation and the dosage of the formulation that has not been able to provide clinical effects on experimental animals.

Conclusion: The SMEDDS formulation of soybean seed extract did not show the ability to reduce LDL lizards or increase HDL levels in rats induced by coronary heart disease.

Pendahuluan: Penyakit jantung koroner merupakan salah satu masalah kesehatan nasional yang mendapat perhatian. Salah satu upaya pengembangan pengobatan penyakit jantung koroner meliputi pemanfaatan bahan alami seperti ekstrak biji kedelai yang memiliki kandungan isoflavon aglikon yang memiliki efek untuk pencegahan disfungsi endotel serta penurunan kadar LDL dalam darah, dimana tingginya kadar LDL dan rendahnya kadar HDL dalam darah sendiri merupakan salah satu faktor risiko dari kejadian penyakit jantung koroner. Senyawa isoflavon aglikon sendiri adalah senyawa non polar yang sulit untuk terlarut dalam air sehingga memerlukan bahan lain untuk meningkatkan penyerapan isoflavon aglikon, salah satunya adalah formulasi Self Microemulsifying Drug Delivery System (SMEDDS) yang dapat membantu meningkatkan solubilisasi dan akses obat ke jaringan limfatik

Metode: Penelitian eksperimental ini dilakukan dengan pendekatan post-test only. Sampel penelitian menggunakan 35 ekor tikus putih yang dibagi menjadi kelompok pertama yang diberikan pakan normal, kelompok kedua yang diberikan pakan tinggi lemak serta kelompok ketiga hingga kelima yang diberikan pakan tinggi lemak dan formulasi SMEDDS ekstrak biji kedelai. Formulasi SMEDDS ekstrak biji kedelai diberikan sebanyak 200mg/mL, 300 mg/mL dan 400 mg/mL dengan menggunakan sonde selama tujuh hari, dua puluh satu hari setelah tikus diinduksi penyakit jantung koroner dengan diet tinggi lemak. Darah tikus kemudia diambil untuk analisis kadar LDL dan HDL. Data dianalisis dengan SPSS untuk windows.

Hasil: Hasil penelitian menunjukkan bahwa tidak terdapat perbedaan yang signifikan pada kadar LDL dan HDL dari tiap kelompok percobaan (p>0,05). Hal ini dapat diakibatkan karena jangka waktu pemberian formulasi SMEDDS yang cukup singkat dan dosis formulasi yang belum dapat memberikan efek klinis terhadap hewan coba

Simpulan: Pemberian formulasi SMEDDS ekstrak biji kedelai tidak menunjukkan kemampuan untuk menurunkan kadal LDL ataupun meningkatkan kadar HDL pada tikus yang diinduksi penyakit jantung koroner

Physical activity and vasomotor symptoms in perimenopausal women at Wukirsari Village, Yogyakarta, Indonesia

Background: Menopause is an event that marks the end of the reproductive phase of a woman. Vasomotor symptoms are one of the primary symptoms of menopausal women and affect about 40-60% of perimenopausal women. This research aims to investigate the relationship of physical activity with vasomotor symptoms in perimenopausal women.

Methods: The population in this study were 173 women aged 45-54 years who are still experiencing menstruation in the Wukirsari village working area of Puskesmas Cangkringan Sleman-Yogyakarta. The instrument for measuring vasomotor symptoms adopted two questions from the menopause rating scale (hot flushes and night sweats) questionnaire while measuring physical activity using a questionnaire from Riskesdas. Data were analyzed using SPSS version 23 for Windows.

Results: Most of the participants were in the 45-50 years age group (75.73%), followed by severe vasomotor symptoms (95.95%), sufficient physical activity (91.91%), medium level education (49.71%), and informal occupation (94.80%). In addition, this study found that most of the participants were normal Body Mass Index (BMI) (54.34%), passive smoking (64.74%), and pre-hypertension (46.20%). There was a significant relationship between physical activities and BMI to the vasomotor symptoms among women of perimenopausal age (p<0.05).

Conclusion: There was a significant relationship between physical activities and BMI the vasomotor symptoms among women of perimenopausal age. 

Interpretasi nilai Cycle Threshold (CT) Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) SARS-CoV-2 pada pasien hamil dengan uji antibodi SARS-CoV-2 positif dan COVID-19 asimtomatik

Background: The majority of pregnant women with COVID-19 will be asymptomatic throughout the disease period. SARS-CoV-2 antibody tests were utilized as a screening tool for patients giving birth in a hospital. Cycle Threshold (CT) value in asymptomatic pregnant women may guide patient management and isolation protocol.

Methods: Research data were obtained from medical records from March until October 2020 with a total sampling method. Pregnant women with positive SARS-CoV-2 antibody and asymptomatic COVID-19 were included. CT-value based on gene primers were grouped and analyzed by Microsoft Excel 365 for Windows.

Results: Twenty-five pregnant women with asymptomatic COVID-19 fulfilled the inclusion criteria. All patients had positive SARS-CoV-2 antibodies. The highest and lowest CT-value for the RdRp gene were 37.91 and 26.90, followed by N-gene (34.37 and 32.16), E-gene (38.36 and 27.60), helicase gene (35.65 and 24.29), ORF1a (35.87 and 26.80), and ORF1ab (41.28 and 27.82).

Conclusion: SARS-CoV-2 antibody test is not a recommended screening tool as it can reveal past infection or immunity to SARS-CoV-2. CT-value is incapable of determining COVID-19 severity and infection period. 

Latar Belakang: Mayoritas pasien COVID-19 dengan kehamilan tidak bergejala sepanjang periode perjalanan penyakit. Uji antibodi SARS-CoV-2 sempat digunakan sebagai alat skrining pasien yang akan melahirkan di rumah sakit. Nilai Cycle Threshold (CT) pada pasien hamil dengan COVID-19 asimtomatik kemungkinan dapat memandu tatalaksana dan isolasi pasien.

Metode: Penelitian ini menggunakan data sekunder rekam medis dari bulan Maret hingga Oktober 2020 dengan total sampling. Data pasien hamil dengan uji antibodi SARS-CoV-2 positif dan terkonfirmasi COVID-19 asimtomatik dianalisis. Nilai cycle threshold (CT-value) berdasar primer dikelompokkan dan dianalisis menggunakan Microsoft Excel 365 untuk Windows.

Hasil: Sebanyak 25 pasien hamil dengan terkonfirmasi COVID-19 asimtomatik memenuhi kriteria inklusi. Seluruh pasien memiliki hasil tes cepat antibodi SARS-CoV-2 reaktif. Nilai CT tertinggi dan terendah untuk gen RdRp sebesar 37,91 dan 26,9, diikuti dengan gen N (34,37 dan 32,16), gen E (38,36 dan 27,60), gen helicase (35,65 dan 24,29), ORF1a (35,87 dan 26,80), dan ORF1ab (41,28 dan 27,82).

Simpulan: Nilai CT tidak dapat digunakan sebagai indikator keparahan gejala dan periode infeksi COVID-19. Pasien hamil dengan COVID-19 asimtomatik tidak harus menjalani isolasi di rumah sakit. 

Hubungan derajat leukopenia terhadap tingkat keparahan penyakit Demam Berdarah Dengue (DBD) pada pasien anak yang dirawat di Ruang Kaswari RSUD Wangaya, Denpasar, Indonesia

Background: Dengue Hemorrhagic Fever (DHF) still becomes a public health problem in Indonesia even in the world.  DHF is caused by the dengue virus with various clinical manifestations such as fever, bleeding manifestations and circulatory failure as well. One of the risk factors of severe dengue infection is leukopenia. This study aims to determine the relationship between the degree of leukopenia and the severity of DHF in pediatric patients treated in the Kaswari room of Wangaya Hospital, Denpasar.

Methods: The research was conducted from December 2018 until February 2019 with a cross-sectional analytical method. The subjects of research were children with DHF, admitted in the Wangaya Hospital and fulfilled the inclusion and exclusion criteria. 58 samples were obtained by using consecutive sampling methods. Data were analyzed using SPSS version 21 for Windows.

Results: Most of the respondents with DHF were known to be > 10 years old, both in the shock group (52.9%) and without shock (48.8%). The dominant sex was male (77.4%) in the shock group while female (62.7%) in the group without shock. There was a significant difference between the degree of leukopenia and the severity of DHF (RP=4.29; 95% CI=1.58-11.57; p=0.003) in this study.

Conclusion: There is a significant association between the degree of leucopenia especially with leukocyte value of <5000/Ul and the severity of dengue hemorrhagic fever especially DHF with shock.

Latar Belakang: Demam Berdarah Dengue (DBD) hingga saat ini masih menjadi masalah kesehatan baik di dunia maupun di Indonesia. DBD disebabkan oleh virus dengue dengan beragam manifestasi klinis, diantaranya adakah demam, manifestasi perdarahan hingga kegagalan sirkulasi darah. Salah satu faktor resiko dari infeksi dengue berat adalah leukopenia. Penelitian ini bertujuan untuk mengetahui hubungan derajat leukopenia terhadap tingkat keparahan penyakit DBD pada pasien anak yang dirawat di ruang Kaswari RSUD Wangaya kota Denpasar.

Metodologi: Penelitian ini menggunakan metode analitik potong lintang yang dilakukan pada bulan Februari 2019. Penelitian ini melibatkan anak dengan DBD yang dirawat di ruang Kaswari RSUD Wangaya kota Denpasar  mulai 1 Desember 2018 sampai 28 Februari 2019. Pengambilan sampel menggunakan metode consecutive sampling. Sampel yang memenuhi kriteria inklusi dan eksklusi adalah 58 sampel. Data dianalisis dengan SPSS versi 21 untuk Windows.

Hasil: Sebagian besar responden dengan DBD diketahui berusia > 10 tahun baik pada kelompok syok (52,9%) maupun tanpa syok (48,8%). Jenis kelamin laki-laki dominan (77,4%) pada kelompok syok sedangkan perempuan (62,7%) pada kelompok tanpa syok. Terdapat perbedaan yang bermakna antara derajat leukopenia dengan tingkat keparahan DBD (RP=4,29; 95%IK=1,58-11,57; p=0.003) pada penelitian ini.

Kesimpulan: Terdapat hubungan yang bermakna antara derajat leukopenia khususnya pada nilai leukosit <5000/Ul terhadap tingkat keparahan demam berdarah dengue khususnya DBD dengan syok. 

Karakteristik gambaran Tuberkulosis (TB) paru pada foto toraks pasien Human Immunodeficiency Virus (HIV) tahun 2017-2021 di RSUP Sanglah, Bali, Indonesia

Background: Tuberculosis is a disease caused by Mycobacterium tuberculosis that mostly attacks the lungs. HIV is a virus that causes damage to the immune system. HIV infection increases the risk of developing pulmonary TB because TB is an opportunistic disease; vice versa TB infection increases HIV progression. This study is about researching the characteristics of TB in HIV patients radiologically at Sanglah Hospital Denpasar.

Methods: This study is a cross-sectional descriptive study conducted retrospectively. The data in this study used medical records of HIV-infected pulmonary TB patients from Sanglah Hospital, especially the characteristics of chest radiographs in the medical records and chest X-rays of patients. For the data collecting technique, a total sample is used to analyze all 47 cases. Data were analyzed using SPSS version 25 for Windows.

Results: Most HIV patients with pulmonary TB coinfection at Sanglah Hospital, Denpasar, were obtained from as many as 47 people. It was found that the age between 30 - 39 recorded to be the highest at 31.3%, men were the most dominant with 81.3%, most of the patients diagnosed with HIV stage 4 were 72.9%, and the most dominant characteristics of the chest radiograph are 41.7% consolidation.

Conclusion: Most cases of pulmonary TB with HIV coinfection at Sanglah Hospital Denpasar in 2017 - 2021 are male around 30 - 39 years. In addition, most of them were diagnosed with HIV stage 4 and finally almost all the patients had consolidation characteristics on chest radiographs.

Latar Belakang: Tuberkulosis adalah penyakit yang disebabkan oleh Mycobacterium tuberculosis yang paling banyak menyerang paru-paru. HIV adalah virus yang menyebabkan kerusakan pada sistem kekebalan tubuh. Infeksi HIV meningkatkan risiko berkembangnya TB paru karena TB adalah penyakit oportunistik sebaliknya infeksi TB meningkatkan perkembangan HIV. Penelitian ini bertujuan untuk mengetahui karakteristik TB pada pasien HIV secara radiologis di RSUP Sanglah Denpasar.

Metode: Penelitian ini merupakan penelitian deskriptif potong lintang yang dilakukan secara retrospektif. Data dalam penelitian ini menggunakan rekam medis pasien TB paru terinfeksi HIV dari RSUP Sanglah, terutama karakteristik foto toraks pada rekam medis dan foto rontgen dada pasien. Untuk teknik pengumpulan data, sampel total digunakan untuk menganalisis semua 47 kasus. Data dianalisis dengan SPSS versi 25 untuk Windows.

Hasil: Pasien HIV koinfeksi TB paru terbanyak di RS Sanglah Denpasar didapatkan sebanyak 47 orang. Didapatkan usia antara 30-39 tahun tercatat paling tinggi 31,3%, laki-laki paling dominan dengan 81,3%, sebagian besar pasien terdiagnosis HIV stadium 4 sebanyak 72,9%, dan karakteristik foto toraks yang paling dominan adalah konsolidasi 41,7%.

Kesimpulan: Kasus TB paru koinfeksi HIV terbanyak di RSUP Sanglah Denpasar tahun 2017 – 2021 adalah laki-laki berusia sekitar 30–39 tahun. Selain itu, sebagian besar terdiagnosis HIV stadium 4 serta hampir semua pasien memiliki karakteristik konsolidasi pada radiografi dada.

The relationship between nutritional status, severity of diarrhea, and length of stay among pediatric patients with diarrhea in Wangaya Regional General Hospital

Background: Diarrhea is a disease still often encountered in society and is one of the biggest causes of death in children. Many factors contributed to the process of diarrhea, including poor nutritional status. According to the data from Riskesdas in 2018, 17.7% of children under five in Indonesia still have nutritional problems. This study was conducted with the aim to know the relationship between nutritional status, the severity of diarrhea and the length of stay among pediatric patients with diarrhea.

Methods: This analytical study uses a cross-sectional design, with a total of 87 samples. Pediatric patients in Kaswari room from January 2019 to July 2020 with diarrhea or gastroenteritis, whose body’s length or height, weight and duration of stay listed in the medical record were included in this study, while patients with congenital abnormality like Hirschsprung disease were excluded from this study. The data collected were analyzed using the Fisher test and Chi-square test.

Results: Out of 87 children, 49 (56%) of them had normal nutritional status, 78 (87.4%) children had modified vesikari score ? 11, and 68 children had a length of stay < 5 days (78.2%). The results of bivariate analysis between nutritional status and diarrhea severity showed that there was no relationship between the two variables (p = 0.426). The same results were obtained in bivariate analysis between nutritional status and length of stay (p = 0.916).

Conclusion: In this study, there was no relationship found between nutritional status, the severity of diarrhea and length of stay among pediatric patients with diarrhea in Wangaya Regional General Hospital.

Peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus

Objective: This systematic review determined the role of HbA1c in the progression and prognosis of COVID-19 in patients with diabetes mellitus from several previously published articles.

Method: We searched from an open-access database according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and the PICO criteria. The inclusion criteria for the article search included: 1) COVID-19 patients with diabetes mellitus; 2) full articles; 3) English articles; 4) article publication time range from 2016 to 2021. Quality assessment for each article is evaluated using a checklist from Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Result: We obtained two cohort studies and four cross-sectional studies of all the articles reviewed from 2019-2021. All studies evaluated the role of HbA1c in the progression, prognosis, and mortality of COVID-19 patients with diabetes mellitus. Most of the reported studies showed an association between elevated HbA1c and worsening of the COVID-19 disease prognosis. The association was assessed by the patient's clinical deterioration included lower oxygen saturation, increased NLR (neutrophil-lymphocyte ratio), the tendency to lymphopenia, improved renal function, increased ICU admission, and mechanical ventilation and increased ventilation mortality.

Conclusion: A high HbA1c was closely related to a worse COVID-19 prognosis in clinical development and mortality. We found the potential for developing a scoring system to predict the worsening and mortality of COVID-19 and improve the quality of prevention and management of COVID-19, especially in patients with diabetes mellitus.

Tujuan: mengkaji peran HbA1c dalam progresi dan prognosis COVID-19 pada pasien diabetes mellitus dari beberapa literatur yang telah dipublikasi sebelumnya.

Metode: Pencarian literatur secara sistematis dilakukan pada basis data dengan akses terbuka sesuai dengan pedoman PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) dan kriteria PICO. Kriteria inklusi pencarian artikel antara lain: 1) pasien COVID-19 dengan diabetes mellitus; 2) artikel lengkap; 3) artikel berbahasa Inggris; 4) rentang waktu terbit artikel dari tahun 2016 hingga tahun 2021. Penilaian kualitas pada setiap artikel yang dievaluasi menggunakan checklist dari Strengthening the Reporting of Observational Studies in Epidemiology (STROBE).

Hasil: Dari seluruh artikel yang dikaji dari tahun 2019-2021, didapatkan 2 studi kohort dan 4 studi potong lintang. Keseluruhan studi mengevaluasi peran HbA1c dalam progresi, prognosis, maupun mortalitas pada pasien COVID-19 dengan diabetes mellitus. Sebagian besar penelitian yang dilaporkan menunjukkan keterkaitan antara peningkatan HbA1c dan perburukan prognosis penyakit COVID-19 yang dinilai dari perburukan klinis pasien yaitu saturasi oksigen yang lebih rendah, meningkatnya NLR (neutrophil lymphocyte ratio), kecenderungan limfopenia, fungsi ginjal yang meningkat, peningkatan admisi ICU dan pemanfaatan ventilator mekanik serta meningkatnya mortalitas.

Simpulan: HbA1c yang tinggi terbukti berhubungan erat dengan prognosis COVID-19 yang lebih buruk ditinjau dari perkembangan klinis hingga tingkat mortalitas yang terjadi. Hal ini menunjukkan potensi berkembangnya sistem skoring untuk memprediksi perburukan dan mortalitas COVID-19 serta peningkatan kualitas pencegahan dan tatalaksana COVID-19 terutama pada pasien diabetes mellitus.

Peran vitamin B6 terhadap inflamasi pada adhesi peritoneal pasca laparotomi: tinjauan pustaka

Vitamin B6 or pyridoxine has been shown to modulate hypoxia and inflammation, but it has not yet confirmed their local effects on the peritoneum. Although there was no study regarding this issue, pyridoxine effects on suppressing these two pathways look promising as a preventing agent against peritoneal adhesion. The development of intraperitoneal adhesion post-operation is one of the most common complications after abdominal surgery. Approximately 95% of patients who underwent laparotomy can develop adhesions in the future. Pathogenesis of adhesion consists of three important processes which were induced by trauma: trauma or direct tissue injury-induced suppression of degradation of fibrinolytic matrix and extracellular system, inflammation response with cytokine production, particularly TGF-? and interleukin, also tissue hypoxia as the impact from circulation disorder toward mesothelial cell and sub-mesothelial fibroblasts, which results as increasing hypoxia-inducible factor-alpha (HIF-1?) and vascular endothelial growth factor (VEGF), which are responsible for generating collagen and angiogenesis process. Pyridoxine has biological activity and interesting characteristics in avoiding intra-peritoneal adhesion by dealing with inflammation effects and hypoxia. From the inflammation process, pyridoxine has been shown can hinder macrophage, decrease IL-6, suppress TLR-mediated TAK1 phosphorylation, JNK, IKK-I?B?, which can cause a reduction in NF-?B activation and NLRP3-mediated caspase-1, also suppress iNOS and cyclooxygenase-2 (COX2), which contributed to developing intra-peritoneal adhesion.

Vitamin B6 (Vit B6), atau piridoksin telah ditunjukkan dapat memodulasi efek hipoksia dan inflamasi, tetapi belum dikonfirmasi efek lokalnya pada peritoneum. Walaupun belum ada penelitian langsung, efek supresi vitamin B6 terhadap kedua jalur tersebut sangat menjanjikan sebagai agen prevensi adhesi peritoneal. Perkembangan adhesi intraperitoneal pasca operasi adalah salah satu komplikasi paling umum setelah operasi abdominal. Sekitar 95% pasien yang menjalani laparotomi akan mengalami perlengketan di kemudian hari. Patogenesis adhesi melibatkan tiga proses penting yang diinduksi trauma: trauma atau kerusakan jaringan langsung menginduksi penghambatan sistem degradasi matriks fibrinolitik dan ekstraseluler, respons inflamasi dengan produksi sitokin, terutama TGF-? dan interleukin, serta hipoksia jaringan sebagai akibat dari gangguan suplai darah ke sel mesothelial dan fibroblas submesothelial, yang mengarah pada peningkatan hypoxia inducible factor-alpha (HIF-1?) dan faktor pertumbuhan endotel vaskular (VEGF), yang bertanggung jawab untuk pembentukan kolagen dan angiogenesis. Vitamin B6 menyajikan sifat dan aktivitas biologis yang menarik untuk mencegah adhesi intraperitoneal dengan mengatasi efek inflamasi dan hipoksia. Pada jalur inflamasi, vitamin B6  terbukti menghambat makrofag, menurunkan IL-6, menghambat fosforilasi TLR-mediated TAK1, JNK, serta IKK-I?B?, yang menyebabkan penurunan aktivasi NF-?B and NLRP3-mediated caspase-1, serta menghambat iNOS dan cyclooxygenase-2 (COX2) yang berkontribusi terhadap pembentukkan adhesi intraperitoneal.

Dietary management in colorectal cancer prevention: a review

Colorectal cancer (CRC) is still a health problem with a high incidence worldwide. Genetic factors and environmental factors are the etiology of colorectal cancer. Eating habits are one of the environmental factors that can be regulated so as to prevent colorectal cancer. Diet food in the development of colorectal cancer has an important role. Several studies in the last decade have shown an association between the consumption of several foods and nutrients and the risk of colorectal cancer in epidemiological and experimental studies.

Potential effect of secondary metabolites in Persea americana seeds as an ?-amylase inhibitor on type 2 diabetes mellitus

Background: Type 2 diabetes mellitus (T2DM) is a disease that has a high prevalence in the world. The development of plants with medicinal potential is an alternative to control blood sugar levels in T2DM disease, such as avocado (Persea americana). Persea americana seeds contain secondary metabolites that have anti-diabetic activity, but their bioavailability is low.

Aim: This study aims to review various secondary metabolites in Persea americana seeds that can reduce blood glucose levels in ?-amylase pathway along with the type of potential encapsulation as a delivery system.

Review: Secondary metabolites contained in Persea americana seeds which have activity as anti-diabetic are tannin, quercetin, rutin, kaempferol, saponin, triterpenoid, and alkaloid. Each of them has several mechanisms in diabetes, but their role as ?-amylase inhibitor on T2DM be in focus. There are various types of encapsulation that are known to be able to serve as a delivery system for these secondary metabolites. Those encapsulations are SNEDDS, chitosan-alginate nanoparticle, PLGA nanoparticle, lipid carrier, liposome, and polysaccharide-based enteric-coated nanoparticle. All of them showed good results in improving bioavailability.

Conclusion: It is known that various secondary metabolites found in Persea americana seeds influence reducing blood glucose levels notably in the ?-amylase pathway. The low bioavailability of secondary metabolites can be improved by several forms of potential encapsulation. Therefore, herbal substances as adjuvant therapy in T2DM might be a viable management option.

Peran terapi mesenchymal stem cell (MSC) dalam penatalaksanaan luka bakar: sebuah tinjauan sistematis

Background: Burn cases are still a challenge and a burden in the health sector due to the morbidity and mortality it causes. The current management of burns has not produced satisfactory clinical outcomes in terms of wound healing. Mesenchymal stem cell (MSC) therapy is known to have an effective curative effect in healing burns. This systematic review aims to determine the role of MSCs in the management of burns.

Methods: A systematic literature review was carried out by searching the literature on Google Scholar, Pubmed and Cochrane Library, where the literature selection used PRISMA diagrams. The inclusion criteria used were studies in the form of clinical trials examining the role of MSCs in the management of thermal burns. The study was not a clinical trial, studies with research samples in the form of non-thermal burns, research subjects were not rats or mice, MSC was not used as the main intervention therapy, and did not involve the control group in the study were excluded so that 12 studies that met the eligibility criteria were obtained.

Results: 12 studies carried out the synthetic analysis in randomized clinical trials using research subjects in the form of mice and rats. The MSC therapy was isolated from bone marrow, cord blood and adipose tissue. MSC therapy plays a role in accelerating the healing process of burns through several biomolecular mechanisms such as reducing apoptosis, suppressing inflammatory responses and oxidative stress, triggering angiogenesis, accelerating re-epithelialization and tissue remodeling. MSC therapy has also been shown to minimize the formation of contractures and scar tissue,

Conclusion: The role of MSC therapy in burns is to accelerate the wound healing process, reduce the occurrence of contractures and scar tissue so that it is very potential to be applied in the management of burns.

Latar Belakang Kasus luka bakar masih menjadi tantangan dan beban di bidang kesehatan akibat morbiditas dan mortalitas yang ditimbulkannya. Penatalaksanaan luka bakar saat ini belum mampu menghasilkan luaran klinis yang memuaskan dari segi penyembuhan luka. Terapi mesenchymal stem cell (MSC) diketahui memiliki efek kuratif yang efektif dalam proses penyembuhan luka bakar. Tujuan dari tinjauan pustaka sistematis ini adalah untuk mengetahui peranan MSC dalam penatalaksanaan luka bakar.

Metode: Tinjauan pustaka sistematis dilakukan dengan pencarian literatur pada Google Scholar, Pubmed, dan Cochrane Library dimana pemilihan literatur menggunakan diagram PRISMA. Kriteria inklusi yang digunakan adalah studi berupa uji klinis yang meneliti peran MSC dalam tatalaksana luka bakar termal. Studi bukan berupa uji klinis, studi dengan sampel penelitian berupa luka bakar non-termal, subjek penelitian bukan berupa tikus atau mencit, MSC tidak digunakan sebagai terapi intervensi utama, serta tidak melibatkan kelompok kontrol dalam studinya dilakukan eksklusi sehingga didapatkan 12 studi yang memenuhi kriteria eligibilitas.

Hasil: Terdapat 12 studi yang dilakukan analisis sintesis berupa uji klinis acak menggunakan subjek penelitian berupa mencit dan tikus. Terapi MSC yang digunakan diisolasi dari sumsum tulang belakang, darah tali pusat dan jaringan adiposa. Terapi MSC berperan mempercepat proses penyembuhan luka bakar melalui sejumlah mekanisme biomolekuler berupa mengurangi apoptosis, menekan respon inflamasi dan stress oksidatif, memicu angiogenesis, mempercepat re-epitelisasi, serta remodelling jaringan. Terapi MSC juga terbukti meminimalisir terbentuknya kontraktur dan jaringan parut,

Simpulan: Peran terapi MSC dalam luka bakar adalah mempercepat proses penyembuhan luka, mengurangi terjadinya kontraktur dan jaringan parut sehingga sangat potensial untuk diaplikasikan dalam tatalaksana luka bakar.

Diagnosis dan penatalaksanaan nodul tiroid tunggal: Sebuah laporan kasus

Background: Thyroid nodules are abnormal lesions in the form of masses or nodules found in thyroid tissue. Thyroid nodules have a prevalence of about 8% in the adult population. A single thyroid nodule is asymptomatic and is generally discovered incidentally on physical examination or imaging. Diagnosis is made by physical examination, imaging examination and cytopathological examination. The management of a single thyroid nodule can be done by providing interventional therapy and surgery. The purpose of this case report is to describe the diagnosis and management of a single thyroid nodule case in Wangaya General Hospital.

Case description: A 52-year-old male patient came to the Surgical Clinic at Wangaya General Hospital with complaints of a lump on the left neck in the past eight months. The lump is felt to be enlarged and painless. The patient's diagnosis was confirmed by cytologic examination, which revealed a follicular nodule with a benign tendency. The patient was given surgical therapy in the form of left thyroidectomy.

Conclusion: Single thyroid nodule is quite rare. Treatment of a single thyroid nodule was adjusted according to the results of the cytologic examination. The prognosis for a single thyroid nodule with benign cytology results is generally reasonable. However, it is necessary to follow-up the patient considering the false negative value of the cytological examination.

Latar belakang: Nodul tiroid adalah lesi abnormal berupa massa atau nodul yang terdapat dalam jaringan tiroid. Nodul tiroid memiliki prevalensi sekitar 8% pada populasi dewasa. Nodul tiroid tunggal bersifat asimtomatik dan umumnya ditemukan secara tidak sengaja saat pasien melakukan pemeriksaan fisik atau pencitraan. Penegakan diagnosis dilakukan dengan pemeriksaan fisik, pemeriksaan pencitraan dan pemeriksaan sitopatologi. Penatalaksanaan nodul tiroid tunggal dapat dilakukan dengan pemberian terapi intervensi dan pembedahan. Tujuan pelaporan kasus ini adalah untuk menjabarkan diagnosis dan penatalaksanaan pada salah satu kasus nodul tiroid tunggal di RSUD Wangaya.

Deskripsi kasus: Seorang pasien laki-laki berusia 52 tahun datang ke Poli Bedah RSUD Wangaya dengan keluhan benjolan pada leher kiri sejak 8 bulan yang lalu. Benjolan dirasakan membesar dan tidak nyeri. Diagnosis pasien ini dikonfirmasi melalui pemeriksaan sitologi yang menunjukkan suatu nodul folikular dengan kecenderungan ke arah jinak. Pasien diberikan terapi pembedahan berupa tiroidektomi sinistra.

Simpulan: Nodul tiroid tunggal cukup jarang terjadi. Terapi nodul tiroid tunggal disesuaikan dengan hasil pemeriksaan sitologi. Prognosis nodul tiroid tunggal dengan hasil sitologi jinak umumnya baik, namun perlu dilakukan follow-up terhadap pasien menimbang nilai negatif palsu dari pemeriksaan sitologi.

Herniasi nukleus pulposus lumbal multipel disertai kanal stenosis dengan drop foot syndrome dan atrofi otot unilateral: sebuah laporan kasus

Background: Low back pain is a fairly common health problem, with a worldwide prevalence of 1.4-20% and an annual incidence of 0.024-7% per year. One of the causes of lower back pain is a herniated nucleus pulposus. The prevalence of nucleus pulposus herniation in Indonesia is not well documented. One of the complications caused by HNP is drop foot syndrome. Drop Foot Syndrome is the inability to perform flexion dorsum movement of the ankle or big toe. The prevalence of drop foot syndrome is quite rare, with around 8.1% of patients suffering from HN^.

Case Illustration: A 71-year-old male patient presented with complaints of lower back pain radiating to the left rear thigh since two months ago. The pain was getting worse, and the legs were getting weaker, so that he had to drag his legs. The patient was also often experiencing back pain since five years ago. The patient has a history as a truck driver with the Bali-Java-Sumatra route for 30 years. On physical examination, there ware significant atrophy in the left calf. Motor examination found that the left foot could not lift against the gravity force, and when walking, the big toe touched the floor first. There was no interference with defecation or bowel movements. Lumbar MRI examination was performed with the results of the disc herniation of L1-L2, L2-L3, L4-L5, L5-S1, multiple canal stenosis, and lumbar spondylosis. Discectomy laminectomy and posterior vertebral fusion were performed.

Conclusion: HNP is one of the most frequent causes of lower back pain. The lack of knowledge about HNP makes people underestimate this problem, and this is one of the causes of complications in the form of drop foot to muscle atrophy due to the delayed treatment.

Latar belakang: Nyeri punggung bawah merupakan permasalahan kesehatan yang cukup umum dengan prevalensi di seluruh dunia sebesar 1,4-20% dan insiden setiap tahunnya 0,024-7%. Salah satu penyebab nyeri punggung bawah adalah herniasi nukleus pulposus. Herniasi nukleus pulposus didefinisikan sebagai rupturnya anulus fibrosus sehingga nukleus pulposus menonjol dan menekan ke arah kanalis spinalis. Salah satu komplikasi yang disebabkan oleh HNP adalah drop foot syndrome. Prevalensi terjadinya drop foot syndrome cukup jarang yakni 8,1% dari pasien yang menderita HNP.

Ilustrasi Kasus: Pasien laki-laki berusia 71 tahun datang dengan keluhan nyeri punggung bawah menjalar hingga paha kiri belakang sejak 2 bulan yang lalu. Pasien baru memeriksakan diri ke dokter karena nyeri semakin berat dan kaki semakin lemas sehingga harus menyeret kaki serta mengalami nyeri punggung belakang sejak 5 tahun yang lalu. Pasien memiliki riwayat sebagai pengemudi truk Bali-Jawa-Sumatra selama 30 tahun. Pada pemeriksaan fisik ditemukan atrofi signifikan pada betis kiri, pemeriksaan motorik didapatkan punggung kaki kiri tidak mampu mengangkat melawan gaya gravitasi dan ketika berjalan bagian jempol kaki menyentuh lantai terlebih dahulu serta tidak didapatkan adanya gangguan pada BAB ataupun BAK. Pemeriksaan MRI lumbalis dilakukan dengan hasil herniasi diskus L1-L2, L2-L3, L4-L5, L5-S1, stenosis kanal multipel dan spondilosis lumbalis. Dilakukan laminektomi disektomi dan fusi vertebra posterior.

Simpulan: HNP merupakan salah satu penyebab nyeri punggung bawah yang paling sering. HNP menjadi salah satu penyebab terjadinya komplikasi berupa drop foot hingga terjadinya atropi otot karena tidak ditangani lebih awal. 

Temuan radiologi dalam kelainan kongenital atresia jejunum: serial kasus

Background: Jejunoileal atresia is an emergency due to mechanical gastrointestinal obstruction, a rare case with a prevalence rate of 1-3 per 10,000 births. There is no difference in incidence by gender. Delay in treatment results in huge losses in terms of malnutrition, failure to thrive, and even death. These case series aim to evaluate radiological findings in congenital jejunal atresia.

Case Presentation: There were 3 patients with the main complaint of bilious vomiting. These three patients underwent a plain abdominal x-ray examination, obtained a picture of a high total obstruction with a triple bubble picture, or had a dilated picture of the proximal obstruction. Partial obstruction based on plain radiographs in one of the patients was found, followed by an examination of contrast meal which filled smoothly up to the jejunum segment with a windsock appearance. The three cases have been proven through surgery, various types of jejunal atresia were obtained. Intestinal resection was performed, followed by an end-to-end jejunal anastomosis.

Conclusion: Correct diagnosis determines the appropriate treatment for the patient. Plain abdominal radiograph as an initial examination in assessing total or partial obstruction in the jejunum, with a typical triple bubble or dilated bowel segment proximal to the obstruction. The windsock appearance of the jejunal segment on the contrast meal confirms the diagnosis of the jejunal web.

Latar Belakang: Atresia jejunoileal merupakan kegawatdaruratan akibat obstruksi mekanik gastrointestinal, yang merupakan kasus jarang dengan angka prevalensi 1-3 per 10000 kelahiran, tidak ada perbedaan insiden berdasarkan gender. Terlambatnya tatalaksana mengakibatkan kerugian yang besar baik malnutrisi, gagal tumbuh, hingga kematian. Laporan kasus ini bertujuan untuk mengevaluasi temuan radiologi dalam kelainan kongenital atresia jejunum.

Laporan Kasus: Terdapat 3 pasien dengan keluhan utama muntah bilosa. Kemudian dari pemeriksaan foto polos abdomen didapatkan gambaran obstruksi total letak tinggi dengan gambaran triple bubble atau memiliki gambaran dilatasi dari proksimal obstruksi. Obstruksi parsial berdasarkan foto polos pada salah satu pasien, dilanjutkan pemeriksaan contrast meal yang mengisi lancar hingga segmen jejunum dengan windsock appearance. Ketiga kasus tersebut telah terbukti melalui hasil operasi, didapatkan atresia jejunum berbagai tipe. Dilakukan reseksi usus dilanjutkan anastomosis end-to-end jejunal.

Kesimpulan: Diagnosis yang tepat, menentukan tatalaksana yang sesuai bagi pasien. Foto polos abdomen sebagai pemeriksaan inisial dalam menilai obstruksi total atau parsial pada jejunum, dengan gambaran khas triple bubble atau dilatasi segmen usus proksimal dari obstruksi. Windsock appearance segmen jejunum pada contrast meal mempertajam diagnosis jejunal web.

Kelainan elektrolit berulang pada pasien dengan kecurigaan Sindrom Gitelman

Pendahuluan: Sindrom Gitelman merupakan tubulopati yang terjadi akibat mutasi pada gen Solute Carrier Family 12 Member 3 (SLC12A3), yang mengkode thiazide-sensitive natrium chloride co-transporter (NCCT) pada membran apikal sel tubulus distal. Sindrom ini bersifat autosomal resesif yang ditandai dengan hipokalemia, alkalosis metabolik, hipomagnesemia, dan hipokalsiuria. Gejala yang sering muncul adalah kram dan kelemahan mulai dari keterbatasan aktivitas ringan hingga berat.

Laporan kasus: Laki-laki usia 19 tahun datang dengan keluhan lemas disertai kaku otot seluruh anggota gerak dan leher, mual, muntah, nyeri kepala, dan nyeri ulu hati. Pasien memiliki riwayat rawat inap tiga kali dengan keluhan serupa. Pada pemeriksaan fisik ditemukan tanda vital dalam batas normal, serta adanya tanda Chvostek. Pemeriksaan darah lengkap dalam batas normal. Pemeriksaan elektrolit menunjukan kadar natrium 118 mmol/L, kalium 2,16 mmol/L, dan klorida 74 mmol/L. Pasien sudah berulang kali melakukan pemeriksaan elektrolit dengan hasil hipokalemia. Delapan bulan sebelumnya, pasien dirawat akibat penurunan kesadaran dengan gambaran alkalosis metabolik, hipokalemia (2,59 mmol/L), hipomagnesemia (0,76 mg/dL) dan hipokalsemia (8,2 mg/dL). Pemeriksaan fungsi ginjal, urinalisis, dan elektrokardiografi dalam batas normal. Berdasarkan keluhan, riwayat penyakit, dan pemeriksaan penunjang berupa hipokalemia berulang, alkalosis metabolik, dan hipomagnesemia, maka dicurigai suatu Sindrom Gitelman. Pasien diterapi dengan kalium klorida (KCl) intravena 50 mEq dalam natrium klorida (NaCl) 0,9% 500 cc dengan laju 20 tetes per menit, tablet KCl 600 mg tiap 8 jam, kapsul garam dapur 500 mg tiap 12 jam, omeprazole serta ondansetron intravena sesuai keluhan. Pasien dirawat inap satu hari dan dipulangkan setelah kadar kalium terkoreksi (3,1 mmol/L) dan keadaan klinis membaik. Pemeriksaan analisis DNA untuk penegakan diagnosis tidak dilakukan karena keterbatasan fasilitas dan biaya.

Kesimpulan: Sindrom Gitelman merupakan tubulopati yang bersifat autosomal resesif ditandai dengan hipokalemia, alkalosis metabolik, hipomagnesemia, dan hipokalsiuria. Tatalaksana sindrom ini tergantung pada klinis dan gangguan laboratorium. Suplemen natrium, kalium, dan magnesium merupakan terapi yang paling sering dibutuhkan.

Introduction: Gitelman syndrome is a tubulopathy that occurs due to mutations in the Solute Carrier Family 12 Member 3 (SLC12A3) gene, which encodes thiazide-sensitive sodium chloride co-transporter (NCCT) in the apical membrane of distal tubule cells. This autosomal recessive syndrome characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalsiuria. Common symptoms are cramps and weakness ranging from mild to severe limitation of activity.

Case Report: a 19 years-old-man present a general weakness accompanied by muscle stiffness throughout the limbs and neck, nausea, vomiting, headache, and heartburn. The patient had a history of hospitalization three times with similar complaints. Normal vital signs and Chvostek's sign were found on physical examination. Complete blood count was within normal limits. Electrolyte examination showed sodium 118 mmol/L, potassium 2.16 mmol/L, and chloride 74 mmol/L. The patient had repeated episode of hypokalemia. In the previous eight months, he was admitted due to decreased of consciousness with metabolic alkalosis, hypokalemia (2.59 mmol/L), hypomagnesemia (0.76 mg/dL) and hypocalcemia (8.2 mg/dL). Kidney function, urinalysis, and electrocardiography within normal limits. Based on complaints, medical history, and the results of investigations a Gitelman syndrome was suspected. The patient was treated with 50 mEq intravenous KCL in 500cc NaCl 0,9% at a rate of 20 drops per minute, 600 mg KCl tablets every 8 hours, 500 mg table salt capsules every 12 hours, intravenous omeprazole and ondansetron as needed. The patient discharged after the potassium level was corrected (3.1 mmol/L) and improved clinical condition. Follow-up examination in the form of DNA analysis was not carried out due to limited facilities and funding.

Conclusion: Gitelman syndrome is an autosomal recessive tubulopathy characterized by hypokalemia, metabolic alkalosis, hypomagnesemia, and hypocalciuria. Management of this syndrome in accordance with clinical and laboratory abnormalities that occur. The most frequently needed therapy are sodium, potassium, and magnesium supplement.

Hemolytic anemia in a 2-years old caused by Glucose 6 Phosphate Dehydrogenase Deficiency (G6PD): a case report

Background: Glucose-6-Phosphate-Dehydrogenase (G6PD) deficiency is an enzyme abnormality related to sex chromosomes (x-linked), which is inherited. The activity or stability of the G6PD enzyme decreases, thus causing the breakdown of red blood cells when an individual is exposed to exogenous substances that can cause oxidative damage. This case study aims to describe a rare case of hemolytic anemia caused by glucose 6 phosphate dehydrogenase deficiency in a two-year-old boy.

Case Presentation: A two-year-old boy presented with agitated, pale, yellowish eyes and body and projectile vomiting after consuming fava beans. He had a prior history of packed red cell transfusion. Physical examination found the conjunctivae were pale with the icteric sclera. Laboratory examination revealed leukocytosis, moderate normochromic normocytic anemia, increased reticulocytes count, and elevated total and unconjugated bilirubin. Peripheral blood smear examination found microcytes, spherocytes, fragmentocytes, and burr cells. Coomb test was negative with decreased G6PD result.

Conclusion: G6PD deficient patients have no symptoms until exposed to oxidizing drugs, infections or after fava beans ingestion which may cause hemolytic anemia and jaundice. Several methods of screening and diagnosis of G6PD can be performed to avoid morbidity and mortality.

Strabismus sebagai komplikasi pemasangan sclera buckle pada ablasio retina regmatogen: laporan kasus

Introduction: Sclera buckle is one of the operative management of rhegmatogenous retinal detachment. Sclera buckle can combine with vitrectomy in young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy stage C, multiple inferior break and recurrent break. Complications from the installation of sclera buckle is one of them the occurrence of strabismus after the installation of sclera buckle. Treatment can be done to remove the sclera buckle and further surgery for extraocular muscle.

Case Description: Male patients aged 31 years, patients present with complaints right eyes rolling inward since 8 months ago. The patient had a history of surgical  sclera buckle and tamponade with silicone oil. Patient also complain blurry vision since 1 month ago after removing silicone oil. The patient has a history of -5.00 glasses in both eyes. In examination obtained Hirschberg esotropia 15 degrees and retinal detachment on right eyes. Patient was diagnosed with right eye Detached Retina post evacuation of silicone oil (16 days), acquired esotropia Suspect et cause sclera buckle installation. Patients are planned to undergo Re-Vitrectomy Pars Plana (VPP), Release Sclera Buckle , Endolaser, Silicon Oil tamponade, and evaluation of extraocular muscle at surgery. During evaluation of extraocular muscle there was fibrosis cover four rectus muscle and no tear was found. Then we removed of fibrosis and released sclera buckle. Strabismus complaint did not feel better after removed of fibrosis so we planned for further action was medial rectus recess with adjustable suture

Conclusion: Sclera buckle can combine with vitrectomy on young people, phakic, myopia more than 6 dioptri, axial length more than 26mm, proliferative vitreoretinopathy, multiple inferior break and recurrent break. Installation of sclera buckle can cause complications in the form of postoperative strabismus. One of the causes of this complication is fibrosis of the extraocular muscles, so there is an attachment called fat adherent syndrome. Treatment that can be taken to treat strabismus after sclera buckle surgery is one of them with the release of sclera buckle, but if strabismus complaints did not improve, surgery can be done on extraocular muscles to improve the position of the ball

Pendahuluan: Sclera buckle merupakan salah satu tindakan operatif dalam menangani ablasio retina regmatogen. Tindakan sclera buckle dapat dikombinasikan dengan vitrektomi pada orang muda, phakia, riwayat miopia lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati stadium C, robekan multiple pada bagian inferior retina dan robekan berulang. Komplikasi dari pemasangan sclera buckle ini adalah salah satunya terjadinya strabismus pasca pemasangan sclera buckle. Penanganan yang dapat dilakukan berupa pelepasan sclera buckle, dan operasi strabismus jika kondisi otot ekstraokular tidak membaik.

Deskripsi Kasus: Pasien laki-laki, usia 31 tahun, datang dengan keluhan mata kanan bergulir ke dalam sejak 8 bulan yang lalu. Keluhan dirasakan setelah pasien melakukan operasi pemasangan sclera buckle dan silicon oil 8 bulan yang lalu. Saat ini pasien juga mengeluhkan pandangan kabur yang sudah dirasakan sejak 1 bulan yang lalu setelah dilakukan pengangkatan silicon oil. Pada pemeriksaan ditemukan Hirschberg esotropia 15 derajat dan ditemukan ablasio retina pada mata kanan. Pasien didiagnosis dengan okuli dekstra rekuren ablasio retina pasca pengeluaran silicon oil  (16 hari), dan kecurigaan esotropia didapat (acquired esotropia)  ec pasca pemasangan sclera buckle. Pasien direncanakan untuk dilakukan Re-Vitrektomi Pars Plana (VPP), pelepasan sclera buckle, endolaser, re-tamponade silicon oil dan evaluasi otot ekstraokular durante operasi. Pada saat dilakukan evaluasi otot ekstraokular ditemukan adanya fibrosis pada keempat otot rektus dan tidak ditemukan adanya robekan pada otot ekstraokular. Kemudian dilakukan pembersihan dari fibrosis dan pelepasan dari sclera buckle. Keluhan strabismus tidak dirasakan membaik pasca dilakukan pembersihan fibrosis sehingga direncanakan untuk dilakukan tindakan lanjutan yaitu medial rectus reses dengan adjustable suture.

Simpulan: Tindakan sclera buckle ini dapat dikombinasi dengan vitrektomi pada pasien muda, phakia, riwayat miopia tinggi lebih dari 6 dioptri, panjang bola mata lebih dari 26 milimeter, ditemukan adanya proliferatif vitreoretinopati, robekan multiple di bagian inferior retina dan robekan berulang. Pemasangan sclera buckle ini dapat menimbulkan komplikasi berupa strabismus pasca operasi. Penyebab dari terjadinya komplikasi ini salah satunya fibrosis pada otot ekstraokular sehingga terjadi perlekatan yang disebut dengan fat adheren syndrome. Tindakan yang dapat dilakukan untuk penanganan strabismus pasca operasi sclera buckle ini adalah salah satunya dengan pelepasan dari sclera buckle, namun apabila keluhan strabismus tidak membaik bisa dilakukan operasi pada otot ekstraokular untuk memperbaiki posisi bola mata.

Pria 80 tahun dengan tumor ganas dinding dada: laporan kasus

Background: Malignant tumors that form in bone, soft tissue, or cartilage, are called sarcomas. Symptoms of these tumors vary, and may include shortness of breath, chest pain, and swelling around the tumor. Imaging such as X-rays and CT scans can be helpful, although imaging features of the few malignant chest wall tumors that are less specific, knowledge of the typical radiographic manifestations of these tumors can often make it easier for experts to differentiate between benign and malignant tumors and help lead to a more specific diagnosis.

Case presentation: An 80-year-old man complains of a lump in the right chest. The results of laboratory tests showed anemia, decreased kidney function, and hypercalcemia. The CT scan of the thorax with contrast showed a solid mass in the right pleural cavity infiltrating the surrounding chest wall muscles, bilateral pneumonia, and osteolytic lesions on the spine suspected of being a metastatic process or spreading malignancy. The results of the biopsy showed a diffuse morphological appearance of immature plasma cells with an approach to the diagnosis of cutaneous infiltration plasma cell myeloma with a differential diagnosis of plasmablastic lymphoma.

Conclusion: The results of X-ray imaging and CT scan of the thorax help narrow the differential diagnosis, where there is an image of a tumor on the chest wall with destruction of the surrounding bone and soft tissue and an image of infiltration into the pleura accompanied by multiple osteolytic images of the vertebrae. Assisted by a biopsy (anatomical pathology), the closest diagnosis in this patient is plasma cell myeloma chest wall.

Latar Belakang: Tumor ganas yang terbentuk pada tulang, jaringan lunak, atau kartilago disebut sarcoma. Gejala dari tumor ini bervariasi, dapat berupa sesak nafas, nyeri dada, dan pembengkakan pada sekitar tumor. Pencitraan seperti rontgen dan CT scan dapat membantu, walaupun gambaran pencitraan dari beberapa tumor ganas dinding dada kurang spesifik, pengetahuan tentang manifestasi tipikal pada radilogi dari berbagai tumor ini seringkali dapat memudahkan para ahli untuk membedakan jenis tumor jinak dan ganas dan membantu mengarahkan diagnosis yang lebih spesifik.

Kasus: Seorang laki – laki berusia 80 tahun dengan keluhan benjolan di dada sebelah kanan. Hasil pemeriksaan laboratorium didapatkan hasil anemia, penurunan fungsi ginjal, dan hiperkalsemia. Hasil CT Scan thorax dengan kontras menunjukkan adanya massa solid pada cavum pleura kanan yang menginfiltrasi otot dinding dada di sekitarnya, pneumonia bilateral, serta lesi osteolitik pada tulang belakang yang dicurigai sebagai suatu proses metastase atau penyebaran keganasan. Hasil biopsi menunjukkan gambaran morfologi sebaran difus sel plasma imatur-matur dengan pendekatan pada diagnosis cutaneus infiltration plasma cell myeloma dengan diagnosis banding plasmablastic lymphoma.

Simpulan: Hasil pencitraan rontgen dan CT scan thorax membantu menyempitkan diagnosis banding, di mana terdapat gambaran tumor pada dinding dada dengan destruksi tulang dan jaringan lunak di sekitarnya serta gambaran infiltrasi ke pleura disertai gambaran osteolitik multipel pada vertebrae. Dibantu dengan pemeriksaan biopsi (patologi anatomi)  maka diagnosis yang paling mendekati pada pasien ini adalah plasma cell myeloma dinding dada

Sindroma Steven–Johnson terinduksi carbamazepine: laporan kasus

Background: Steven-Johnson syndrome (SJS) is characterized by skin, mucosal, and eyes lesions caused by complex immune mechanisms or hypersensitivity reactions. In children, SJS incidence isn’t well–known because its clinical profiles aren’t well–recognized. One of the causes of SJS is due to the use of drugs. This report aims to describe carbamazepine–induced SJS.

Case: Twelve–year–old girl came with oral lesions for 1 week preceded by vesicles all over her body. This happened 3 days after taking carbamazepine, and it was her first time consuming it. On examinations, she was alert but weak with good nutritional status, had an axillary temperature of 37.7°C. Both her eyes were red and watery. She developed multiple ulcers in her mouth with a hyperemic pharynx. There were vesicles all over her body, but no abnormalities were found on thorax and abdomen examinations. Laboratory tests results showed neutrophilia, lymphocytopenia, eosinophenia, and hyponatremia. She was then diagnosed with SJS and was hospitalized. The doctor advised her to stop taking carbamazepine, and she received D₅ ½ NS 2,000 cc/ 24 hours, dexamethasone injection 3 x ½ ampule, paracetamol injection 3 x 500 mg, betamethasone cream, triamcinolone oral-based cream, and oral cetirizine 1 x 10 mg. After 8 days she was discharged in good condition.

Conclusion: SJS is characterized by skin, mucosal, and eyes lesions which are mostly caused by drugs. One of the most common drugs causing SJS is antiepileptic such as carbamazepine. 

Latar Belakang: Sindroma Steven - Johnson (SSJ) ditandai dengan berbagai tanda diantaranya kelainan kulit, mukosa orifisium, dan lesi pada mata yang disebabkan oleh reaksi kompleks imun atau hipersensitivitas. Angka kejadian SSJ pada anak tidak diketahui dengan pasti, hal ini kemungkinan disebabkan oleh manifestasinya yang kurang dikenali. Salah satu sebab timbulnya SSJ adalah oleh karena penggunaan obat-obatan. Laporan kasus ini ditulis dengan tujuan untuk memberi gambaran mengenai SSJ pada remaja akibat obat carbamazepine.

Kasus: Remaja perempuan berusia 12 tahun datang dengan luka pada mulut dan lidah sejak 1 minggu sebelumnya yang didahului oleh mata merah dan bintik merah berisi cairan di seluruh tubuh. Keluhan timbul 3 hari setelah mengkonsumsi carbamazepine dan ini adalah pertama kalinya pasien mengkonsumsi obat tersebut. Pada pemeriksaan ditemukan pasien sadar, tampak sakit berat, didapatkan status gizi baik, suhu tubuh 37,7°C, kedua mata hiperemis difus, hiperlakrimasi, ulkus multipel berkrusta pada bibir dan lidah disertai faring hiperemis. Ditemukan adanya vesikel generalisata namun tidak ditemukan kelainan pada pemeriksaan thoraks dan abdomen. Hasil laboratorium menunjukkan neutrofilia, limfopenia, eosinopenia, dan hiponatremia. Pasien didiagnosis dengan SSJ. Pasien disarankan untuk menghentikan carbamazepine dan mendapatkan terapi cairan D₅ ½ NS 2.000 cc/24 jam, injeksi deksametason 3 x ½ ampul, injeksi parasetamol 3 x 500 mg, krim betametason, sediaan krim oral triamsinolon, dan cetirizine oral 1 x 10 mg. Setelah dirawat selama 8 hari pasien dinyatakan sembuh dan dipulangkan.

Simpulan: SSJ memiliki gambaran klinis yang melibatkan lesi pada kulit, mukosa orifisium, mata, dan sebagian besar dicetuskan oleh obat. Salah satu obat yang sering menyebabkan SSJ adalah obat antikonvulsan pada pasien yang memiliki kecenderungan genetik.